A Radiologist Answers All Your Questions About Breast Cancer Prevention in the Time of COVID-19

Vogue speaks with a diagnostic radiologist about navigating breast cancer prevention amid the pandemic and beyond.

Breast Cancer Awareness Month has come and gone, but that’s no reason to stop raising awareness, or carefully considering the ways to reduce risk for yourself and loved ones. This is a critical message always—but especially now, stresses Mia Kazanjian, MD, a diagnostic radiologist at Norwalk Radiology Consultants. “Breast cancer screening really took a hit during the pandemic,” explains Kazanjian, citing a survey conducted by the American Cancer Society that estimates 35% of Americans have missed a routine cancer screening due to COVID-19-related fears and service disruptions. Moreover, the Centers for Disease Control and Prevention has indicated that breast cancer screening declined about 87% when the pandemic peaked and numbers have not fully recovered since, even though screening centers have instituted every possible protocol to keep patients safe from COVID 19.

Given that breast cancer is the most common cancer in women after skin cancer, and about 1 in 8 U.S. women (about 13%) will develop invasive breast cancer over the course of her lifetime, this poses a dramatic health challenge—and one with serious consequences, especially among women already experiencing health inequities. “Annual screenings are incredibly important to do because if you don’t do it, it could be picked up later, which could be dangerous,” explains Kazanjian, emphasizing that regular mammograms help detect breast cancer at an early stage, when treatment is most successful. “I want to make sure that one public health crisis, i.e. COVID-19, doesn't cause another health crisis: the delay and loss of screenings, and otherwise preventable cancer deaths,” she continues. “That's what really keeps me up at night.”

To help you navigate breast cancer prevention within the pandemic landscape and beyond, we spoke to Kazanjian about how COVID-19 has impacted breast cancer screenings and why it’s vitally important to get an annual mammogram to aid in early detection.

How has the pandemic impacted breast cancer screenings in the U.S.?

“The long and short of it is that we’ve seen a significant decrease in the numbers of patients coming in during the pandemic. During the peak of COVID-19 last year, screening was suspended for several months because the infection rates were so high. But once the Society of Breast Imaging reinstated the recommendation that we should have screening again, there was really a lag in women coming back in. That’s what I’ve still been seeing. In other words, some women skipped the last year [due to the suspension]. Take for example a woman who was due in June of 2020. A lot of those women who were due didn't end up scheduling their appointments for [later in the year], they skipped last year completely.

The entire year went by and nobody came in, and it's not a fault of theirs...things were still scary at the end of last year! But the problem with that is if you don't get screened every year, and if you pick up a cancer over the next year, which we've been seeing, they're picked up at a later stage, so they've grown in size. Two years does make a big difference and that's why I'm so passionate about having women come in every year, and especially in light of COVID because people did defer.”

In addition to COVID-19 fears, what else might be at the root of delayed screenings?

Another thing I've seen is people who are scared just to come in for a screening to begin with because they're scared of being told [bad] news. They're scared that they might have a problem and want to stay away from that. I think some women are in denial if they're having symptoms and they’re worried that there could be a problem, so they keep pushing it off. I would say, however, the biggest thing that we see and have always seen is that women are the caretakers of their family. They take care of others before they take care of themselves. That's something that really kind of sits deeply with me because I've diagnosed women like that. It's so painful to see because it's like, ‘Oh, I had to take care of my husband who had prostate cancer or, my son was going to college and I had to go on the tour and I had to do this and I had to do that.’ And they just let their own health lag. One of my main messages is we have to take care of ourselves to be able to take care of others. You're not going to be there potentially to help other people if you're not healthy. The bottom line is that early detection when something is still tiny gives the very best chance of treatment.

What should you expect from a mammogram, and why is it the most important step in breast cancer screening?

Breast cancer screening with 3D mammography, or tomosynthesis, is basically like watching a movie through the breast. The technology is incredible and has improved tremendously. We started doing 3D mammography in 2013. That’s allowed us to see and detect a lot more and write off findings that aren’t significant but might’ve been worked up because we can actually see things three-dimensionally. If that's done every year, it's highly, highly sensitive for finding tiny breast cancers. It just takes minutes. It's a fast exam! The treatments have improved dramatically, too. In terms of surgeries, there are less invasive treatments now. Decades ago, women had to have mastectomies even for small lesions, now they’re doing lumpectomies and I work with surgeons where you can barely see the scar. The earlier you find it, the smaller the area to remove.

What about self-exams?

Self-exams were supported more in the past. The American Cancer Society doesn’t recommend them anymore. Generally the reason for that is that several research studies have shown that there's very little evidence to say that it makes a difference. All the studies have shown that the annual mammogram is the most effective way to screen. That said, I still encourage patients to know what their breasts feel like because I have had patients who pick up their breast cancers. Another reason why is that by the time somebody feels a cancer, it's often bigger. The whole goal of what I'm saying in screening and doing it every year is you want to find [breast cancer] when it's millimeters in size. [With a self-exam] you're going to probably find it when it's later. However, even though it's not recommended, it's not discouraged. I would still say women should know what their breasts feel like. And it’s not just about feeling lumps, it could be that something’s pulling in or there’s nipple discharge. People need to pay attention and know their bodies.

In the time of COVID-19, fear is a huge factor. How do you encourage women to fight against this and stay on top of their screenings?

COVID taught us a lot and one of the effects of it is: We want to live again. We want to be able to be in the world again, and we want to be able to connect to people again. We all see people going to restaurants and concerts again, and part of doing that and living again is taking care of your health. Going to the doctors should just be a natural part of that experience. Let's minimize the stigma and the fear around this. Go get your mammogram, go get your pap smear. Life is so precious. We have to be able to preserve it for ourselves so that we can be here not only for ourselves, but also our loved ones.

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This story originally appeared on: Vogue - Author:Lauren Valenti